Understanding Psychopathology

Case Study: Subjectivity, Censorship and Truth

As a student (going on thirty years), I was given the opportunity to work at a Child Psychiatric outpatient facility for a year and a half. I did assessments as well as therapy under supervision. In my spare time, I would go down into the archives and read past case histories. The medical charting provided a pragmatic basis for understanding the nature of child and adult psychopathology. One of my principle observations, was that children until they were approximately eight years old would provide an accurate description of their inner lives and conflicts when tested using projective tools. Simple projective art work provided by the child such as a drawing of a tree or the family would often provide clues to the dramatic existential conflicts the child was faced with. The projective test par exellence is the dream, which can work and be used for clinical purposes. After eight years old, children began to learn to censor their communication and expression. The censor works in two directions not only were they able to hide their thoughts and feelings from others but also from themselves. Dissimulation and ingratiation towards others and self-deception are examples of the process. This situation constitutes what has been termed as split subjectivity. Consciousness and the unconscious aspects of the mind no longer commune. At this point, we then have lost our sense of authenticity, as well as our direct access and awareness of our unconscious processes. We no longer commune with ourselves, others or our dreams. This is why most of us do not understand the communication of the dream, nor do we understand our symptoms caused by censorship that we experience in our waking life. Censorship creates an existential experience of split subjectivity with ourselves and others. Censorship undercuts our perception causing blindness and deafness to the truth, most often an emotional truth. Revealing the narrative gaps caused by the censorship in the life stories of individuals and humanity is paramount to healing psychopathology.

Two cases illustrate our subjectivity process.

CASE 1: Munchhausen by Proxy

A child (7 years) was referred for therapy with the referral reason being, symptoms of an unspecified phobia. The child would not leave the mothers side and had to sleep in the parents bedroom because of the fears. These behaviours appeared three months prior to the referral. After closely listening to the mother and child, I asked the child what she was afraid of, and why she needed to be with her mother? The child responded with "I don't know". I then asked the child if she could play in our play room so that I could talk to her mommy and if she needed to come back in the room she could knock. In this case, I did not need a dream from the mother or the child, I had received all the information I needed in the therapeutic transference provided by both. What I understood was that the fears were not coming from the child, instead they were coming from the mother. This is why I needed to talk to the mother alone, to confirm. Asking the mother a variety of questions, the mother disclosed that she had been abused as a seven year old, the abuser was never brought to justice.

The thoughts, feelings, symptoms and (mostly likely dreams) were induced by the mother into the child. Clinicians know this symptom pattern as Munchhausen by Proxy. In this case, given the history we can easily understand the mother's motives. The psychiatrist R.D. Laing Politics of the Family believed that each generation projects and induces experiences onto the next. I informed the mother that if she took back her own projections (memories/fears/thoughts of abuse) that the child should return to her previous socalled "normal" behaviour. I scheduled a check up session two weeks later, the mother reported at that time that the child was again sleeping in her own bed and playing outside with other children. The mother had stopped projecting the worst.

CASE 2: Lost in the Internet Triangle

A 17 year old was referred for symptoms of depression by his mother. The adolescent had lost close to 30 pounds in weight. I spoke to the mother first who reported that her son was involved in an Internet relationship triangle, it was his first love. They spoke on the phone, exchanged pictures and chatted on the Internet everyday. I asked the mother whether the relationship had been "consummated", the mother replied "no". I then spoke to the son and his narrative matched his mothers' almost exactly. I asked him, had he consummated the relationship and he also said "no". I replied that I believe that he had. He looked at me quizzically as if to say "your strange", he again stated somewhat more emphatically, that he had not consummated the relationship. I again stated he had. He then said, "how do you figure?". I said, "I have one question, have you had sexual dreams with this girl." This question found the affirmative. It was obvious, you don't loose close to 30 pounds without there being a very strong relationship both in mind and in body. From a popular musical perspective, the emotional and imaginative aspects that laments love lost is best expressed in a song by Rod Stewart The First Cut is the Deepest (see music video).

All material Copyright 2006 International Institute for Dream Research. All rights reserved.